The meniscus is a C-shaped cartilage disk that is found in the knee. Meniscal tear | Radiology Reference Article | Radiopaedia.org There is a history of sudden inability to fully extend the knee, with a rotational flexion/extension 'trick' required to regain full extension. Those that extend through the entire width of the meniscus are particularly harmful (16a,16b), and even if such tears appear stable following repair, they are unlikely to regain the ability to provide hoop stress to the meniscus.13 Radial tears have therefore classically been treated with partial meniscectomy, though evolving surgical techniques have led to successful reports of the repair of radial tears that communicate with the meniscal periphery.11 A recent report has even described the successful repair of radial tears of the medial meniscal root,14 utilizing a tibial tunnel through which sutures are placed in the avulsed meniscus, a technique similar to that used in patients undergoing meniscal transplantation. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. The ideal candidate for a medial meniscal root repair is an individual younger than 40 years who presents after an acute, traumatic event with a BMI less than 30 and a MRI that shows a medial meniscal root tear without secondary signs of osteoarthrosis or varus malalignment. We believe these tears are more degenerative in nature, and there is no evidence to support that by repairing these medial meniscal root tears, knee degeneration will be postponed or stopped. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. We have two menisci in either knee. Pain is typically medial and activity-related (e.g. Br Med Bull 2007;84:523. While visualization of the meniscal root may be difficult due to MRI slice size, type of MRI and strength of MRI, an extrusion larger than 3 mm highly correlates with a root tear. In cases where surgery is required, this time frame increases to somewhere around three to four months. If the test is positive (suggesting a meniscal tear), the patient will feel pain and the clinician will feel and/or hear meniscal movement when the meniscus is compressed between the tibia and femur 32, Figure 2. As recognition of the critical function of the menisci in normal biomechanical function of the knee has grown, attempts at preserving meniscal tissue via repair as opposed to partial meniscectomy have also gained favor. This website also contains material copyrighted by third parties. What to Do If Your Orthopaedic Surgery Is Postponed. Complex degenerative tear. The majority of these types of tears do not need surgery. Orthopaedic Basic Science: Foundation of Clinical Practice. 11 Plain radiography is only useful to exclude differentials and computed tomography (CT) is markedly inferior to MRI for meniscal imaging.12 Magnetic resonance imaging is the gold standard, first choice for investigation of suspected meniscal tears.2,1316. J Fam Pract 2001;50:93844. A recent study demonstrated 46% of patients with degenerative meniscal tears elected not to have surgery after 4 weeks of nonoperative treatment, and their functional improvement matched patients in the operative group.21 Another study of degenerative tears demonstrated that supervised exercise caused the same reduction in knee pain and the same increase in function and satisfaction as partial meniscectomy plus exercise.23 As degenerative tears are more common in elderly patients, this group is more likely to respond to conservative treatment. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. J Bone Joint Surg Am 1988;70:120917. As the risk of osteoarthritis is increased if meniscal structures are not optimally functional,7 it may also be appropriate to refer all young patients for opinion if symptoms do not rapidly improve. It is important to describe your symptoms accurately. Also write down any new instructions your provider gives you. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. What Is a Tear of the Anterior Horn of the Lateral Meniscus? This region of the outer meniscus, sometimes referred to as the red zone, is thought to occupy approximately 15% of the peripheral meniscus.4 Tears that occur within the red zone of the meniscus are more likely to heal than those in the avascular, white zone of the meniscus. Before your visit, write down questions you want answered. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Meniscus Radial Tear | George Gendy MD As people age, they are more likely to have degenerative meniscus tears. A meniscus can be split in half, ripped around its circumference in the shape of a C or left hanging by a thread to the knee joint. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. It is important that these root avulsions are anatomically repaired back to the bone. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. This technique allows for anatomic reduction and fixation of the meniscal root by restoring the joint contact pressure and area similar to the intact state. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. Detailed review of funding for diagnostic imaging services. swelling . Age of injury peaks at 2029 years.7 Partial meniscectomy (removal of the torn section) is one of the most commonly performed orthopaedic surgical procedures.8. (6a) A radial tear of the body of the lateral meniscus also appears vertical on sagittal MR images (arrow), though in the case of radial tears, the lesion is oriented perpendicular to the c-shaped fibers of the meniscus. One of the most common knee injuries is a torn meniscus. Because the pieces cannot grow back together, symptomatic tears in this zone that do not respond to conservative treatment are usually trimmed surgically. Meniscus tears can happen during physical activities, but they can also occur from: Sometimes, a torn meniscus can occur due to degenerative changes in the knee, even if there is little to no trauma. Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on. One of the main tests for meniscus tears is the McMurray test. There are numerous types of meniscus tears, including: This type of tear is often a sign of degenerative changes in the meniscus tissue. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. So the injury as seen in MRI scan means there is an tear in the medial meniscus towards the posterior side, that is towards the back of joint. Symptoms. If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. 2nd ed. Your doctor might move your knee and leg into different positions, watch you walk, and ask you to squat to help pinpoint the cause of your signs and symptoms. Know why a test or procedure is recommended and what the results could mean. meniscal tear / avulsion off tibial plateau CIRCUMFERENTIAL FIBERS basicall equivalent to a total meniscetyomy - try to repair these at all cost! Walking can become difficult. There are numerous types of meniscus tears, including: 1. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. Meniscus Tear Repair Surgery: What To Expect & Recovery Time - WebMD Clin Orthop Related Res 2010;468:11902. What is an oblique tear of the meniscus? - Rampfesthudson.com Medial meniscal root tears: Fix it or leave it alone Orthopedics Today | Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and. All rights reserved. The views expressed by the authors of articles in Australian Family Physician are their own and not necessarily those of the publisher or the editorial staff, and must not be quoted as such. The doctors at the Orthopaedic Associates of Central Maryland are here to repair your knee problems, hip pain, and arthritis issues so you can get back to enjoying life. AJSM 2007; 35:1380-1383. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. With the realization that even partial meniscectomy leads to accelerated osteoarthritis,2 surgeons have increasingly turned to meniscal repair. A referral to an orthopedic physician should result in guidance it means you need to see in orthopedist and get an opinion as to whether. The surgery requires a few small incisions and takes about an hour. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. Meniscus Tear Wiki Arthroscopy. The posterior horn is the thickest and most important for overall function of the knee. Larger, unstable tears of this type often cause mechanical symptoms, however, and therefore warrant operative treatment, usually via partial meniscectomy. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. Torn meniscus - Diagnosis and treatment - Mayo Clinic Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. Weakness, grinding, instability or giving way rarely result from meniscal pathology. These tears often require surgical treatment to restore the proper function of the knee. However, coronal sections may reveal the presence of meniscal extrusion or vertical defects, and sagittal sections may reveal the ghost sign (absence of an identifiable meniscus or increased signal replacing the normal hypointense signal of meniscal tissue).
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